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Toxic shock syndrome
Toxic shock syndrome (TSS) is a rare but life-threatening condition caused by bacteria getting into the body and releasing harmful toxins.
It's often associated with tampon use in young women, but it can affect anyone of any age – including men and children.
TSS gets worse very quickly and can be fatal if not treated promptly. But if it's diagnosed and treated early, most people make a full recovery.
Symptoms of toxic shock syndrome
The symptoms of toxic shock syndrome (TSS) start suddenly and get worse quickly. They include:
a high temperature
flu-like symptoms, such as a headache, feeling cold, feeling tired or exhausted, an aching body, a sore throat and a cough
feeling and being sick
diarrhoea
a widespread sunburn-like rash
lips, tongue and the whites of the eyes turning a bright red
dizziness or fainting
difficulty breathing
confusion
Sometimes you may also have a wound on your skin where the bacteria got into your body, but it may not look infected.
Important:
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At the moment it can be hard to know what to do if you or your child is unwell. 
It's important to trust your instincts and get medical help if you need it.
When to get medical advice
Toxic shock syndrome (TSS) is a medical emergency.
While these symptoms could be due to a different condition, it's important to contact your GP, a local out-of-hours service, or NHS 111 as soon as possible if you have a combination of these symptoms.
It's very unlikely that you have TSS, but these symptoms should not be ignored.
Go to your nearest A&E department or call 999 and ask for an ambulance immediately if you have severe symptoms or they are rapidly getting worse.
If you're wearing a tampon, remove it straight away. Also tell your doctor if you've been using a tampon, recently had a burn or skin injury, or if you have a skin infection such as a boil.
If a doctor suspects you have TSS, you'll be referred to hospital immediately.
Treatment for toxic shock syndrome
If you have toxic shock syndrome (TSS), you'll be admitted to hospital and may need to be treated in an intensive care unit.
Treatment for TSS may involve:
antibiotics to treat the infection
in some cases, purified antibodies that have been taken out of donated blood, known as pooled immunoglobulin, may also be given to help your body fight the infection
oxygen to help with breathing
fluids to prevent dehydration and organ damage
medicine to help control blood pressure
dialysis if your kidneys stop functioning
in severe cases, surgery may be needed to remove dead tissue. Rarely, it may be necessary to amputate the affected area
Most people will start to feel better within a few days, but it may take several weeks before you're well enough to leave hospital.
Causes of toxic shock syndrome
Toxic shock syndrome (TSS) is caused by either staphylococcus or streptococcus bacteria.
These bacteria normally live on the skin and in the nose or mouth without causing harm, but if they get deeper into the body they can release toxins that damage tissue and stop organs working.
These things can increase your risk of getting TSS:
using tampons – particularly if you leave them in for longer than recommended or you use "super-absorbent" tampons
using female barrier contraceptives, such as a contraceptive diaphragm or cap
a problem with your skin, such as a cut, burn, boil, insect bite or a wound after surgery
childbirth
using nasal packing to treat a nosebleed
having a staphylococcal infection or streptococcal infection, such as a throat infection, impetigo or cellulitis
TSS is not spread from person to person. You do not develop immunity to it once you've had it, so you can get it more than once.
Preventing toxic shock syndrome
The following things can reduce your risk of toxic shock syndrome (TSS):
treat wounds and burns quickly and get medical advice if you notice signs of an infection, such as swelling, redness and increasing pain
always use a tampon with the lowest absorbency suitable for your period
alternate between tampons and a sanitary towel or panty liner during your period
wash your hands before and after inserting a tampon
change tampons regularly – as often as directed on the pack (usually at least every 4 to 8 hours)
never have more than one tampon in your vagina at a time
when using a tampon at night, insert a fresh tampon before going to bed and remove it when you wake up
remove a tampon at the end of your period
when using female barrier contraception, follow the manufacturer's instructions about how long you can leave it in
It's a good idea to avoid using tampons or female barrier contraception if you've had TSS before.
Page last reviewed: 27 September 2019
Next review due: 27 September 2022
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